Provider Demographics
NPI:1366084824
Name:JOHNSON, NIKITA (CPM, DOULA)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPM, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 DORSEY HALL DR # 203-D
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7869
Mailing Address - Country:US
Mailing Address - Phone:667-303-2336
Mailing Address - Fax:410-204-5176
Practice Address - Street 1:5024 DORSEY HALL DR # 203-D
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7869
Practice Address - Country:US
Practice Address - Phone:667-303-2336
Practice Address - Fax:410-204-5176
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, LayGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000000000000000000Medicaid
MD000000000000000000OtherNURSING SERVICE RELATED PROVIDERS TYPE